measuring identification with the mothering role

Research in Nursing and Health, 1980,3, 49-56

Measuring Identification with the Mothering Role

Barbara Lippincott Rees

Three summated rating scales entitled Feelings of Motherliness (FOM), Conception of the Fetus as a Person (CFP), and Appropriateness of Fantasies about the Baby-to-be (AFB) were constructed. During instrument development, data were collected from a sample of 169 women selected using the criteria of gravidity, ethnicity, and experience. Thirty-four of these women were used to test the final versions of the scales. Coefficient alphas for FOM, CFP, and AFB were .87, .89, and .67, respectively. Coefficient alphas for the subscales ranged from .88 to 1 .O. Content validity was built into the scales. The data supported the concept validity of FOM and CFP, but not AFB. Three subscales of the Parental Attitude Research Instrument were used as criterion measures; criterion validity was not established. Construct validity was assessed using convergent and discriminant measures. Data provided support for convergent validity, but not for discriminant validity. Further modification and testing of the scales are needed.

A problem facing the nursing profession today is the allocation of time and resources to meet the health needs of childbearing families. All too frequently the decision about which family needs concentrated nursing care seems to be made primarily on the basis of the socioeconomic status of the family, rather than on the basis of the family’s ability to cope with its changing roles and responsibilities. It is apparent that criteria are needed that are appropriate for identifying the family that needs concentrated nursing care, the areas in which the Eamily needs the additional care, and the point in time that the nursing intervention will be most beneficial to the family.

The concern of this investigation was the identification of criteria that would be helpful in predicting, before delivery, the amount of nursing assistance a primipara would need in learning to adjust to and care for her new baby. It was assumed that new mothers with low levels of maternal feeling would need more assistance in learning to care for their babies than would new mothers with high levels of maternal feeling. The purpose of

this study was to develop instruments that would permit measurement of the primigravida’s identification with the mothering role. Specifically, instruments were designed to measure the primigravida’s feelings of motherliness, her conception of the fetus as a person, and the appropriateness of her fantasies about the baby-to-be.

The construct of identification with the mothering role was defined as the extent to which a woman formulates a mental conception of the attitudinal and behavioral attributes that characterize a mother and then assumes these attitudinal and behavioral attributes herself. Benedek (1970, p. 156) stated that “the term ‘identification’ is often used to represent the incorporated image of the total mother.” Deutsch (1945) noted that the pregnant woman’s identification with her own mother started in childhood and con- tinues through her pregnancy. Rubin (1967) studied 9 women throughout their pregnancies and for 1 month following delivery. She identified four distinct operations involved in “taking in” the maternal role: mimicry, role playing, fantasy, and a circular process of

This research was conducted as partial fulfillment of the requirements of Dr. Rees’s doctoral

The author wishes to thank Drs. Jan Atwaod, Eleanor Bauwens, and Beverly McCord for con- degree program.

tributing their comments and suggestions during instrument development.

@ 1980 Wiley 0160-6891/80/02049-08 $01 .OO 49

SO RESEARCH IN NURSING AND HEALTH

introjection-projection-rejection. The end result of these operations was identification with the mothering role.

The concept of feelings of motherliness was defined as the extent to which a female experiences a spontaneous desire to look after, care for, or nurture a child. This spontaneous desire is behaviorally expressed each time the female becomes involved in a situation with a child.

Benedek (Note 1 , p. 44) stated that “motherliness is the characteristic quality of the woman’s personality which supplies the emotional energy to maintain the tedious and repetitious tasks of mothering.” Iorio (1968) said that a woman’s mothering behavior springs from two sources. One source is rooted in the woman’s physiology; the other develops under environmental influences and is inherent in the woman’s personality. Steele and Pollack (1974) noted that motherliness has its roots in the mother’s own in- fancy.

Levy (1942, 1960, 1970) and Levy and Hess (1952) were responsible for much of the research done in the area of maternal feeling. Levy (1942, p. 223) found that maternal behavior was a “characteristic feature of the personality in childhood as well as in later life.” Gardner (1971) used Levy’s criteria in the development of interview questions used to rate maternal feeling. Examples of some of the factors that were taken into consideration in determining the extent of a woman’s maternal feeling are the woman’s favorite games as a child, the role she played in those games, how long she played with dolls, how she felt about baby-sitting, how soon after marriage she would have preferred to have had her first child, and whether or not she thought of herself as a good flirt.

The concept of conception of the fetus as a person was defined as the extent to which an expectant mother attributes individual qual- ities or characteristics to her unborn child. Caplan (1959) stated that during pregnancy, expectant mothers begin to develop a set of attitudes toward the fetus. Factors that he identified as being useful in determining a woman’s personalization of the fetus include when the expectant mother begins to feel that the fetus is “real,” how conscious she is of fetal movements, the kinds of feelings she experiences when the fetus moves, how she refers to the fetus, whether or not she plays with the fetus, and whether or not she as- cribes feelings to the fetus.

The concept of appropriateness of the fantasies about the baby-to-be was defined as the extent to which the daydreams an expectant mother has about her baby as it will be after birth conform to what could realisti- cally be expected of the baby and reflect an emotional tone that would be compatible with the newborn infant’s well-being. Caplan (1959) stated that many women have intense fantasy lives during pregnancy. Aspects of an expectant mother’s fantasies that he considered to be of value in determining the fu- ture mother-child relationship include the age and sex of the baby, the activities the mother is engaged in with the baby in the fantasy, the extent to which the mother knows exactly what the baby will be like, and the emotional coloring of the fantasy.

It was postulated that the concepts of feelings of motherliness, conception of the fetus as a person, and appropriateness of the fantasies about the baby-to-be represented three different aspects of the construct identification with the mothering role. Ben- edek (1970) noted that psychoanalytic concepts of identification assume that a woman’s motherliness and her mothering behavior are derived from her identification with her own mother. Caplan (1959) stated that psycho- genic changes occurring during pregnancy might be related to development of the mothering role.

As stated previously, the purpose of this study was to develop summated rating scales that would measure the primigravida’s feelings of motherliness, conception of the fetus as a person, and appropriateness of fantasies about the baby-to-be.

METHOD

Subjects

The subjects of the study were selected solely on the basis of the theoretical criteria of gravidity, ethnicity, and experience. The subjects were women in the last trimester of pregnancy who classified themselves as being Anglo (Barth, 1969) and who would be assuming for the first time the roles of primary care givers to their children. All subjects were recruited from an antepartal clinic in a 260-bed teaching hospital or from among expectant parents attending childbirth prep- aration classes in the Southwest. During data collection periods, all women meeting the criteria were asked to participate. A total of

MEASURING MATERNAL IDENTIFICATION / REES 5 1

169 subjects agreed to participate throughout instrument development. Before data were collected from any subject, the study was approved by a university Human Subjects Committee.

The sample for the final testing of the instruments consisted of 34 first-time expectant mothers. Fourteen expectant mothers were recruited from the antepartal clinic, and 20 were recruited from childbirth education classes. For the purpose of generalizability, data were collected on age, marital status, gravidity, and social position. Subjects ranged in age from 16 to 34 years. Six women were single: 28 were marrried. Eight women reported previous pregnancies. Subjects were classified according to Hollingshead’s (1977) Two Factor Index of Social Position, where Class I denotes high social position and Class V denotes low social position. The distribution was as follows: 4 women in Class I, 7 women in Class 11, 8 women in Class 111, 13 women in Class IV, and 2 women in Class V.

Retest data were collected from 14 of the 34 subjects. One of the 14 subjects recruited from the antepartal clinic and 13 of the 20 subjects recruited from childbirth education classes completed all three test administrations. The reason that the majority of the subjects from the clinic failed to return for one or two test administrations may have been that they would have had to make a special trip to the clinic to complete the questionnaire, whereas the subjects from the childbirth classes completed the questionnaire at their scheduled classes. The distribution of the 14 subjects who completed all three test administrations was fairly similar to the distribution of the entire sample in re- gard to age and social position. However, 13 of these 14 expectant mothers were married, and all were primigravidas.

Procedure

Four drafts of the Rees scales [Feelings of Motherliness (FOM), Conception of the Fetus as a Person (CFP), and Appropriate- ness of Fantasies about the Baby-to-be (AFB)] were compiled and tested. After a re- view of the literature, interviews with pregnant women were conducted to determine the relevance of the material obtained from the literature search. Content areas were then outlined for each concept. Questions were developed that were potentially repre-

sentative of the content of each of the areas. Two maternal-child specialists reviewed these questions for content. The first drafts of the instruments were then assembled and tested. The three subsequent drafts of the instruments were compiled using essentially the same procedure, except that the number of judges was increased from two to three. In addition, data collected from the scale administrations were analyzed for patterns of interitem and item total correlations.

The final drafts of the FOM, CFP, and AFB were administered to 34 respondents, who were told that participation in the research project entailed completing a questionnaire once a week for three consecutive weeks. Respondents were not told that the questionnaire items would be the same every week.

instruments

These final drafts of the Rees scales con- tained items consisting of statements fol- lowed by six response options on a con- tinuum ranging from “strongly agree” to “strongly disagree.” To minimize response sets (Guilford, 1967; Robinson, Rush, & Head, 1974), items were made as interesting and as nonthreatening to the respondents as possible, and the statement wording was varied from positive to negative. An even number of response options was used to pre- vent a neutral response bias.

RESULTS

Data analyses during scale development revealed that the FOM, CFP, and AFB were multidimensional in nature. Therefore, subscales in each scale were identified, named, and developed. Table 1 lists the acronyms used for the scales and subscales. Subscales in the FOM were designed to index the subconcepts Imaginative Play (IP), Experiences with Children (EC), Infant Feeding (IF), and Feelings of Nurturance (FN). Subscales in the CFP were designed to index the subconcepts Talking About the Baby (TAB), Talking To the Fetus (TTF), Reaction to Fetal Movement (RFM), and Interaction With the Fetus (IWF). Subscales in the AFB were designed to index the subconcepts Daydream- ing About the Baby-to-be (DAB) and Day- dreaming About the Child-to-be (DAC). Table 2 presents samples of the items con- tained in each scale.

5 2 RESEARCH IN NURSING AND HEALTH

Table 1. and Subscales of Mothering

Acronyms for the Rees and PARla Scales

Acron y m Interpretation ~~

AA Approval of activity AFB Appropriateness of fantasies about

CFP Conception of the fetus as a person DAB Do ydrea m i ng a bout the baby-to-be DAC Daydreaming about the child-to-be EC Experiences with children FHB Fear of harming the baby FN Feelings of n urturance FOM Feelings of motherliness IF Infant feeding IM Irritability of the mother IP Imaginative play IWF Interaction with the fetus PAR1 Parental attitude research

instrument RFM Reaction to fetal movement RHR ss Suppression of sex TAB Talking about the baby TTF Talking to the fetus

5chaefer & Bell ( 1 958).

baby-to-be

Rejection of the homemaking role

Internal Consistency

Estimations of the internal consistency of the final drafts of the Rees scales and their subscales are presented in Table 3. Coefficient alphas for the FOM and CFP ex- ceed the minimum expectation of .80, whereas the coefficient for AFB falls below .80. The subscales have coefficient alphas ranging from .68 to .90. These coefficients

are considered respectable because of the difficulty in achieving high coefficients with small numbers of scale items (Bohrnstedt, 1970).

Stability

Test-retest data were collected on the FOM, CFP, and AFB three times so that coefficients of stability (Heise, 1969) could be calculated. Stability coefficients range from .88 to 1 .O. These coefficients are higher than expected. Respondents’ memories of their previous answers (Bohrnstedt, 1970), especially between the second and third test administrations, and loss of respondents between the first and third test administrations may have inflated the stability coefficients.

Content Validity

Content validity was built into the Rees scales through use of the literature. Content areas for each concept were identified, and items representative of each content domain were written. A final check on the content validity of the final versions of the FOM, CFP, and AFB was made by obtaining agreement from a panel of three judges on the appropriateness of the item content of each subscale in each scale.

Concept Validity

The validities of the concepts of feelings of motherliness, conception of the fetus as a

Table 2. Sample Items from the Rees Scales FOM, CFP, and AFB

Type of Scale Subscole wording Statements

FOM IP EC

IF FN

CFP TAB TTF

RFM

IWF AFB DAB

DAC

+ +

+ + -

When I was a child, I liked to play house. As a teenager, I would have baby-sat whether or not I got paid for it. Breastfeeding can be embarrassing for a mother. I think that many newborn babies are rather funny looking. I usually talk about my baby to anyone who will listen. It i s unusual for a pregnant woman to try to talk to her unborn bo by. When I felt my baby move for the first time, I didn’t think much about it. I can tell when my baby i s getting excited. I think of myself burping my baby after a feeding. I think of my baby as a child going to school.

MEASURING MATERNAL IDENTIFICATION / REES 53

Table 3. Their Subscales

Estimations of Internal Consistency for the Rees Scales FOM, CFP, and AFB and

No. of Cronbach’s No. of Cronbach’s No. of Cronbach’s Scale items alpha Scale items alpha Scale items alpha

FOM 30 .87 CFP 28 .89 AFB 20 .67 IP 9 .69 TAB 5 .79 DAB 10 .84 EC 7 .74 TT F 5 .80 DAC 10 .89 IF 6 .68 RFM 8 .73 FN 8 .79 IWF 10 .90

Note. N = 34.

person, and appropriateness of fantasies about the baby-to-be were tested by analyzing the correlations between each subscale and its individual items, the correlations between the scales and their respective subscales, and the intercorrelations among the subscales of each scale to determine convergence.

With a .05 level of significance and a correlation of .35 as minimum criteria, it was found that 64 of 78 items correlate satis- factorily with their respective subscales, thereby providing support for the validity of the subconcepts. The remaining 14 items do not meet the criteria for retention in the subscales.

Correlations among FOM, CFP, and their respective subscales are presented in Tables 4 and 5. All correlations are significant at the

Table 4. Its Subscales

Pearson Correlations among FOM and

FOM IP EC IF FN

FOM 1.00 .88* .84* .32* .81* IP 1 .oo .77* .22 .51* EC 1.00 -.09 .60* IF 1.00 . 1 1 FN 1 .oo

Note. N = 34. * p C .05

Table 5. Subscales

Pearson Correlations among CFP and Its

CFP TAB TTF RFM IWF

CFP 1.00 .66* .77* .51* .86* TAB 1 .oo .42* .24 .38* TTF 1 .oo .15 .63* RFM 1 .oo .23 IWF 1 .oo Note. N = 34 * p 6 .05.

.05 level, except for the correlations between IF and IP, EC, and FN and between RFM and TAB, TTF, and IWF. The magnitude of the correlation between IP and EC indicates that those subscales measure the same sub- concept and should be combined into one subscale. The significant correlation of FOM and CFP with their respective subscales and the convergence of three of the subscales in each scale provide support for the validity of the concepts of feelings of motherliness and conception of the fetus as a person. The lack of significant correlations between IF and IP, EC, and FN and between RFM and TAB, TTF, and IWF may indicate that attitudes toward infant feeding are not a part of the concept of motherliness and that the feelings experienced by the mother when she first notices fetal movement are not a part of the concept of personalization of the fetus.

The correlation between AFB and subscale DAB is .20 and is not significant. The correlation between AFB and subscale DAC is .70, and the correlation between DAB and DAC is -.47. Both of these correlations are significant at the .05 level. The negative correlation between DAB and DAC was not expected because the subscales were designed to correlate positively with one another. This negative correlation may be the result of a social desirability response set (Nunnally, 1978). The validity of the concept of appropriateness of fantasies about the baby-to-be is not supported by the data.

Criterion Validity

Three subscales from the Parental Attitude Research Instrument (PARI) by Schaefer and Bell (1958) were used as criterion measures for FOM, CFP, and AFB. The subscales are Rejection of the Homemaking Role (RHR), Irritability of the Mother (IM), and Fear of Harming the Baby (FHB). Cor-

54 RESEARCH IN NURSING AND HEALTH

Pearson Correlations among the Rees and PARP Scales and Subscales Table 6.

Rees scales PAR1 subscales

FOM CFP AFB RHR IM FHB ss AA

Rees scales FOM (.87) .59* .22 .30* .02 .14 CFP (.89) -.06 .12 -.07 .20 AFB (.67) .1 1 -.01 .02

PAR1 subscales RHR (.50) .42* .25 IM (.51) -.07 FHB (.W ss AA

.19 .54* - .03 .29*

. 1 1 -.13

.53 .37*

.16 .12

.12 .23 (.33) .41*

(.74)

Note. N = 34. Alpha coefficients estimated from the current sample are in parentheses. aSchaefer & Bell ( 1 958). *p S .05.

relations of FOM, CFP, and AFB with RHR, IM, and FHB are presented in Table 6. Be- cause rejection of the homemaking role, irritability of the mother, and fear of harming the baby were thought to be inversely related to the concepts of feelings of motherliness, conception of the fetus as a person, and appropriateness of fantasies about the baby- to-be, the prediction was that FOM, CFP, and AFB would correlate moderately and negatively with the three subscales. This prediction proved to be inaccurate. The only significant correlation found is a positive correlation between FOM and RHR. Criterion validity of the Rees scales is not established.

Construct Validity

The Rees scales are indicators of the construct on maternal identification. Therefore they were not expected to correlate significantly with demographic characteristics of the sample, because maternal identification is a process dependent primarily on psychological developmental tasks (Deutsch, 1945). As expected, the correlations between the scales and gravidity, marital status, and social position are not significant (Table 7). However, a significant correlation is found between age and scales FOM and CFP. Perhaps the current ability of a woman to control her own life experiences, including pregnancy, may influence the association between age and scales FOM and CFP. If one assumes that a woman chooses to become pregnant, either consciously or subconsciously, then many

women who choose to become pregnant when young probably see motherhood as a primary goal in life. That is, they probably choose to become pregnant because of their identification with the mothering role.

A modified version of the convergent and discriminant validation procedure developed by Campbell and Fiske (1959) was used to estimate the validity of the construct on maternal identification. According to the theoretical framework, the concepts of feelings of motherliness, conception of the fetus as a person, and appropriateness of fantasies about the baby-to-be are different aspects of the construct of identification with the mothering role. Therefore it was predicted that the correlations among FOM,

Table 7. Pearson Correlations of Rees and PAR1 Scales and Subscales with Demographic Charac- teristics of the Sample

Scale Gravidity

Rees scales FOM -.04 CFP -.06 AFB . 1 1

RHR -.18 IM -.lo FHB .17 ss .08 AA -.14

PAR1 subscales

Ma ri ta I status

- .40* -.28* - .05

-.lo .04

-.21 - .36* - .44*

.03

.04

.20

-.14 .03

-.19 -.30* - .09

Social position

.12

.27 -.lo

.o 1 - .03 .28 .33* .30*

Note. N = 34. *p G .05.

MEASURING MATERNAL IDENTIFICATION / REES 5 5

CFP, and AFB would be moderately high and positive. Correlations among the scales are presented in Table 6. The correlation between FOM and CFP is moderately high and positive, as predicted, thereby providing support for the convergent validity of the construct. The AFB does not correlate as predicted with FOM and CFP.

Two subscales of the PARI (Schaefer & Bell, 1958). Suppression of Sex (SS) and Ap- proval of Activity (AA), were used to estimate the discriminate validity of FOM, CFP, and AFB. According to Campbell and Fiske (1959). among measures using the same method, measures of the same construct should correlate more substantially with each other than with measures of different constructs. Therefore, it was predicted that correlations among FOM, CFP, and AFB would be positive and higher than the correlations of each of the subscales SS and A A with each of the scales FOM, CFP, and AFB. Correlations among FOM, CFP, and AFB and correlations of these Rees scales with the PARI subscales are presented in Table 6. Since the estimate of the reliability of SS for the current sample is only .33, and because AFB fails to adequately measure the concept on fantasies, the correlations of SS and AFB with the other scales and subscales are considered theoretically meaningless. The correlation between FOM and CFP is higher than the correlation between CFP and AA, but it is not higher than the correlation between FOM and AA. These positive correlations between A A and scales FOM and CFP were not expected. A factor that may have influenced the relationship between AA and the scales is the demographic characteristic of age. Table 7 shows that age corre- lates significantly with FOM, CFP, and AA. Discriminant validity of the scales is not es- tablis hed .

DISCUSSION

Although estimations of reliability and validity of FOM and CFP are adequate, further modifications of these scales are indicated. Subscale IF in FOM and subscale RFM in CFP should be deleted. All items that do not meet the minimum criteria for retention in the other subscales need to be revised or removed.

Estimations of internal consistency and stability for AFB vary from minimally

adequate to good. Validity of the scale is poor. Reliability and validity of AFB may be improved if a suspected social desirability response set is removed.

Estimations of criterion and construct validity were made. Unexpected correlations between the demographic characteristic age and scales FOM and CFP were found. These associations warrant further exploration. A correlation of .59 between FOM and CFP provides support for the convergent validity of the construct. Criterion and discriminant construct validity were not established. Ad- ditional estimates of these latter two types of validity are needed using more appropriate criterion and discriminant measures.

REFERENCE NOTE

1 . Benedek, T. Mothering and Nurturing. Paper presented at the National Child Nursing Confer- ence, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, 1966.

REFERENCES Barth, F. Ethnic groups and boundaries. Boston: Little,

Brown, 1969. Benedek, T. Motherhood and nurturing. In E. J. An-

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Bohrnstedt, G. W. Reliability and validity assess- ment in attitude measurement. In G. F. Summers (Ed.), Attitude measurement. Chicago: Rand- McNally, 1970.

Campbell, D., & Fiske, D. Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 1959,56, 81-105.

Caplan, G. Concepts of mental health and consultation (Children's Bureau Publication No. 373-1 959). Washington, D.C.: Children's Bureau, Welfare Administration, U.S. Department of Health, Edu- cation, and Welfare, 1959.

Deutsch, H. The psychology of women (Vol. 2). New York: Grune & Stratton, 1945.

Gardner, R. A proposed scale for the determination of maternal feeling. Psychiatric Quarterly, 1971,

Guilford, J. P. Response biases and response sets. In M. Fishbein (Ed.), Attitude theory and measurement. New York: Wiley, 1967.

Heise, D. R. Separating reliability and stability in test-retest correlation. American Sociological Re- view, 1969, 34, 93- 101.

Hollingshead, A. B. Two factor index of social position. In D. Miller (Ed.), Handbook of research design and social measurement. New York: McKay, 1977.

45, 23-34.

5 6 RESEARCH IN NURSING AND HEALTH

lorio, J. Parent-child relationship: .Implications for nursing. In A. Clark, M. Bunnell, & E. Henning (Eds.), Parent-child relationships: Role of the nurse. New Brunswick, N.J.: Rutgers University Press, 1968.

Levy, D. M. Psychosomatic studies of some aspects of maternal behavior. Psychosomotic Medicine, 1942,

Levy, D. M. A method of analyzing clinical observa- tions of relational behavior. In P. Hoch & J. Zubin (Eds.), Current approaches to psychoanalysis. New York: Grune & Stratton, 1960.

Levy, D. M. The concept of maternal overprotection. In E. J . Anthony & T. Benedek (Eds.), Parenthood: I t s psychology and psychopathology. Boston: Little, Brown, 1970.

Levy, D. M., & Hess, A. Problems in determining

4, 223-227.

maternal attitudes towards newborn infants. Psy- chiatry, 1952, 15, 273-286.

Nunnally, J. C. Psychometric theory. New York: McGraw-Hill, 1978.

Robinson, J. P., Rush, J . G., & Head, K. 6. Criteria for an attitude scale. In G. M. Maranell (Ed.), Scoling: A sourcebook for behavioral scientists. Chicago: Al- dine, 1974.

Rubin, R. Attainment of the maternal role (Part 1). Nursing Research, 1967, 16, 237-245.

Schaefer, E. S., & Bell, R. Q. Development of a parental attitude research instrument. Child Develop- ment, 1958,29, 339-36 1.

Steele, B. F., & Pollock, C. B. A psychiatric study of parents who abuse infants and small children. In R. E. Helfer & C. H. Kempe (Eds.), The battered child. Chicago: University of Chicago Press, 1974.

Dr. Barbara L. Rees is a postdoctoral student in the College of Nursing, University of Arizona,

This article was received July 1 1, 1979, was revised, and on January 12, 1980 was accepted for

Requests for reprints may be addressed to Dr. Barbara L. Rees, 4335 N. Flecha Drive, Tucson,

Tucson, Arizona.

publication.

Arizona 8571 8.

measuring identification with the mothering role

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